Ultra-Processed Food Consumption is Associated with Alcoholic Beverage Drinking, Tobacco Smoking, and Illicit Drug Use in Adolescents: A Nationwide Population-Based Study

Background: Although evidence suggests that ultra-processed food (UPF) consumption may trigger addictive behaviors, the association between UPF intake and psychoactive substances remains unclear among adolescents, a group especially vulnerable to addiction and its potentially harmful effects on health. Objective: To analyze the association between the consumption of UPF and alcohol, tobacco, and illicit drugs in adolescent students. Method: This cross-sectional study analyzed data from the National School-Based Health Survey (PeNSE 2019), which collected information from a representative population-based sample of students aged 13–17 years in Brazil. UPF consumption was self-reported in a 24-h recall. Lifetime and use of alcohol, tobacco, and illicit drugs in the last month were also reported. Multinomial logistic regression models estimated the relative risk ratios (RRR) (95% confidence intervals – CI) because the outcome variables comprised four categories representing varying frequencies of use of psychoactive substances. Results: The mean ± standard error number of different UPF consumed among the 95,074 adolescents included (52.3% girls) was 4.37 ± 0.02. The results from adjusted models revealed that, compared to those who reported low UPF consumption (1^st tertile), those who consumed more UPF (3^rd tertile) were more likely to report frequent (≥ 3 days in the last month) drinking of alcoholic beverages (RRR = 2.19; 95% CI: 1.87, 2.56), illicit drugs (RRR = 2.22; 95% CI: 1.87, 2.85) and occasional (one or two days in the last month) smoking (RRR = 1.30; 95% CI: 1.05, 1.60). Conclusions: UPF consumption was associated with alcohol, tobacco, and illicit drug use in a national sample of Brazilian adolescents.